Long-Term Care and Residential Care Facilities

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• What are the general COVID-19 recommendations for nursing homes and other long-term care institutions?
  • Encourage everyone (e.g., healthcare personnel, patients, and visitors) to remain up to date with all recommended COVID-19 vaccine doses.
  • Establish a process to identify and manage individuals with suspected or confirmed SARS-CoV-2 infection.
  • Implement source control measures, such as use of respirators or well-fitting facemasks or cloth masks to cover a person’s mouth and nose to prevent spread of respiratory secretions when they are breathing, talking, sneezing, or coughing.
  • Take measures to limit crowding in communal spaces.
  • Improve ventilation delivery and indoor air quality in patient rooms and all shared spaces.
  • Perform SARS-CoV-2 Viral Testing.
  • Have a plan for how SARS-CoV-2 exposures in a healthcare facility will be investigated and managed and how contact tracing will be performed.
  • Dedicated medical equipment should be used when caring for a patient with suspected or confirmed SARS-CoV-2 infection.
  • Routine cleaning and disinfection procedures.
• What is the investigative process?
  • Public Health Services becomes aware either through a call from the facility, a medical record report noting a nursing home or through matching a patient’s positive lab result against a list of known addresses of nursing home or long-term care facilities (LTCF).
  • Initial assessment steps include:
    • Connect with the facility point of contact (POC) and evaluate for an outbreak using the outbreak definitions and intake form.
    • Review CDC COVID-19 recommendations:
      • Suspected or Confirmed Cases in Healthcare Settings
    • Instruct the facility to evaluate their stock of PPE using the COVID-19 LTCF PPE Assessment document. If additional PPE and/or environmental cleaning/disinfection supplies are needed they should send an email to the County of San Diego’s Medical Operations Center.
    • If the facility has symptomatic residents and testing would aid classifying the outbreak, then offer testing via Public Health Lab (PHL).
      • At minimum, request 4 nasopharyngeal (NP) swabs be submitted from ill residents/staff.
      • Complete PHL requisition form and order testing for ‘2019-nCoV’ and Influenza PCR.
      • Ensure that the requisition form accompanies the specimen to PHL.
      • Inform PHL of incoming outbreak specimens.
• What actions are taken during an outbreak investigation?
  • Conduct a facility assessment which includes establishing POC.
  • Review and provide guidance on infection control and prevention measures.
  • Provide a surveillance log for facilities to record detections, characterize and investigate their outbreak.
  • The facility should immediately report to the investigator if a second laboratory-confirmed COVID-19 case is identified, or if a resident/staff member develops ARI. If afterhours, contact the Epidemiology Program Duty Officer.
  • Request updates from the POC. Immediately notify if surge in cases, increase in severity of illness, hospitalizations, or a death occurs.
  • If the facility cannot fully implement all recommended precautions, then the Epidemiology Unit and medical directors should be consulted on alternative options (e.g., transfer of cases to a fully equipped facility).
  • Ongoing work with the facility with frequent check in.
  • Keep the outbreak open for the 14-day monitoring period. After 14-days, confirm with the POC that no new cases have been identified. 

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• Where can I express a concern or complaint about a long-term care facility?
  • Report concerns or complaints to the appropriate state licensing entities:
    • California Department of Public Health (CDPH) – for Skilled Nursing Facilities
      • State office: (916) 552-8632 or go on-line here.
      • Local office: (619) 278-3700
    • California Department of Social Services, Community Care Licensing Division (CCL) – for Residential Care Facilities for the Elderly, Adult Residential Facilities (assisted living facilities, board and care facilities)
      • State office: (844) 538-8766 or send an email.
      • Local office: (619) 767-2300 or send an email.
      • You can also report concerns or complaints to the County of San Diego Long-Term Care Ombudsman program: (800) 640-4661 or send an email.
• What special measures should be taken to help residents with dementia, intellectual disabilities, and/or mental health challenges?
  • The local office of the licensing entity for a particular facility (such as the California Department of Public Health or the California Department of Social Services) is a good resource for consultation regarding specific situations/challenges.
  • For residents with dementia, it might also be helpful to consult with staff at Alzheimer’s San Diego (858-492-4400) and the local chapter of the Alzheimer’s Association (619-678-8322 and 24/7 Helpline at 800-272-3900).  
  • In addition, the following materials contain helpful guidance:
    • Best Practices for Caring for Individuals with Dementia During COVID-19 from the California Department of Social Services, Community Care Licensing (CCLD)
    • COVID-19 Materials for People with Intellectual and Developmental Disabilities and Care Providers | CDC
    • The Dementia-Friendly Activities Toolkit is a resource to support caregivers and families alike looking for simple and easy ways to engage with their loved ones.
    • SCDD Plain Language COVID Vaccine Information (ca.gov)

  Tips on using plain language and meaningful words when speaking with people with intellectual disabilities can be found here.

• How can I obtain PPE (personal protective equipment) for staff?
  • You can get equipment such as masks, gowns, and face shields by sending an email to the County of San Diego’s Medical Operations Center.